J of Evolution of Med and Dent Sci/ eissn , pissn / Vol. 4/ Issue 07/Jan 22, 2015 Page 1122

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1 A STUDY OF KNOWLEDGE, ATTITUDE & PRACTICE OF FAMILY PLANNING METHODS AMONG ANTENATAL WOMEN OF ANDHRA PRADESH Shailaja Pinjala 1, Padmavathi Tatavarthi 2, Syamala G 3 HOW TO CITE THIS ARTICLE: Shailaja Pinjala, Padmavathi Tatavarthi, Syamala G. Torsion of Gravid uterus. Journal of Evolution of Medical and Dental Sciences 201; Vol. 4, Issue 0, January 22; Page: , DOI: /jemds/201/18 ABSTRACT: Objective: To assess the knowledge and attitude regarding family planning and the practice of contraceptives among Antenatal women attending OPD and to determine the prevalence of unintended pregnancy among them. METHOD: A cross sectional descriptive study was done in the Obstetrics and Gynecology Department of Andhra Medical College Visakhapatnam which is a tertiary center for three districts Visakhapatnam, Vijayanagaram, and Srikakulam. 499 antenatal women attending the OPD were included in the study. Their knowledge, attitude and practice on contraceptives were evaluated with the help of a predesigned questionnaire. RESULTS: Overall awareness of permanent methods of family planning 96.3% and that of temporary methods is only 62.9% (314). 69.9% of women became aware of contraceptive method, by obtaining information from relatives and friends and 23.2% from media (television). 42.1% are of the opinion that these contraceptive methods are available in the medical shops and only 13% know that they are available in the government hospitals. 99.8% are aware of female sterilization, and 92.8% are aware of vasectomy. But awareness of temporary methods is very poor. CONCLUSION: The study highlights that knowledge and awareness doesn t always lead to the use of contraceptives. There is still a need to educate and motivate the couples and improve family planning services to achieve more effective and appropriate use of contraceptives and to arrest the trend towards increase in population. KEYWORDS: Family planning, contraception, knowledge, attitude, practice. INTRODUCTION: India was the first country in the world to launch the NATIONAL FAMILY PLANNING PROGRAMME with the aim to reduce the birth rate and to stabilize population. Since its inception in 191, this programme has experienced a significant growth in financial investment, service delivery points and in the range of contraceptive products delivered. Of late this programme has been integrated with the broader Reproductive and Child health programme. But the uncontrolled population growth which is already exceeding 1 billion (all set to overtake China and become the most populous country in the world by 204), still remains the single greatest threat to the political, economic and social development of the country. (1) Though the Couple Protection Rate has quadrupled and the Total Fertility Rate reached 1.98, there are several issues and goals that still remain under achieved. A significant proportion of pregnancies continue to be unplanned, and contraceptive needs of millions of women remain unmet. Several population groups including adolescents and men continue to be neglected and underserved. The contraceptive scenario is characterized by the predominance of non-reversible methods. (2) AIM: To assess the knowledge, attitude and practice of various family planning methods among the antenatal women, to project the difference in knowledge and practice of various methods and also to assess the prevalence of unintended pregnancies. J of Evolution of Med and Dent Sci/ eissn , pissn / Vol. 4/ Issue 0/Jan 22, 201 Page 1122

2 MATERIALS AND METHODS: The present study is a cross-sectional observational study that is carried out in KING GEORGE HOSPITAL Visakhapatnam Andhra Pradesh. 499 women are selected randomly among the antenatal women attending the out-patient department. These women are interviewed based on a pre-designed questionnaire. The questionnaire elicited information regarding their age, educational status, income, awareness and practice of the various male and female, temporary and permanent methods of contraception. The results are analyzed by SPSS. RESULTS: Fig. 1 Fig. 2 J of Evolution of Med and Dent Sci/ eissn , pissn / Vol. 4/ Issue 0/Jan 22, 201 Page 1123

3 Fig. 3 variables number percentage Age 1-20 y y y >30y 1 3 Area of residence Rural Urban Urban slums Religion Hindu Muslim Christian Education Illiterate Primary Secondary >secondary Occupation House wife Labourer Service Business Husband education Illiterate Primary Secondary >secondary Husband occupation Laborer 28.1 Unskilled Skilled Professional business 0 10 J of Evolution of Med and Dent Sci/ eissn , pissn / Vol. 4/ Issue 0/Jan 22, 201 Page 1124

4 Marital status <1y y y > Number of children Nil Table 1 knowledge practice Variables Yes No p-value yes No p-value Age 1-20 years (111) 20-2 years (299) 2-30 years(4) >30 years(1) Area of Residence Rural (14) Urban (212) Urban Slum (142) Occupation House wife (43) Laborer (12) Service (13) Business (1) Religion Hindu (442) Muslim (14) Christian (43) 61 (.0) 19 (6.9) 4 (63.) 9 (60.0) 8 (60.0) 134 (63.2) 93 (6.) 300 (63.4) (41.) 8 (61.) 1 28 (62.9) 29 (6.4) 0 (4.0) 102 (34.1) 2 (36.) 6 (40.0) 8 (40.0) 8 (36.8) 49 (34.) 13 (38.6) (8.3) (38.) (3.1) 14 (32.6) (31.) 14 (49.2) 43 (8.1) 8 (3.3) 64 (44.1) 102 (48.1) 6 (4.2) 221 (46.) (41.) 6 (46.2) (46.2) (3.) 24 (.8) 6 (68.) 12 (0.8) 31 (41.9) (46.) 81 (.9) 110 (1.9) (2.8) 22 (3.3) (8.3) (3.8) 238 (3.8) 9 (64.3) 19 (44.2) 0.002** J of Evolution of Med and Dent Sci/ eissn , pissn / Vol. 4/ Issue 0/Jan 22, 201 Page 112

5 Education Illiterate (60) Primary (62) Secondary (26) > Secondary (112) Husband Education Illiterate (1) Primary (48) Secondary (234) > Secondary (146) Husband Occupation Laborer (28) Unskilled (14) Skilled (128) Professional (22) Business (0) Marital Status <1 Years (142) 1-2 Years (8) 3- Years (16) > Years (10) Number of Children No children (28) 1 Children (212) 2 Children (9) 28 (46.) 30 (48.4) 161 (60.8) 9 (84.8) 3 (2.1) (62.0) 108 (4.0) 160 (6.1) 9 (64.3) 9 (4.2) 16 (2.) 34 (68.0) 8 (61.3) (6.) 106 (64.2) 64 (61.0) 11 (61.) 138 (6.1) (.6) 32 (3.3) 32 (1.6) 104 (39.2) 1 (1.2) 34 (4.9) (38.0) 38 (26.0) 12 (43.9) (3.) 33 (2.8) 6 (2.3) 16 (32.0) (38.) 30 (34.) 9 (3.8) 41 (39.0) 10 (38.) 4 (34.9) 4 (44.4) Table ** 0.002** 0.00** (36.) 2 (40.3) 120 (4.3) 66 (8.9) 2 (38.0) (4.3) 6 (2.1) 126 (44.2) 4 (28.6) 9 (46.1) 14 (63.6) 30 (60.0) (40.1) 4 (4.0) 83 (0.3) 46 (43.8) 126 (4.3) 103 (48.6) 4 (44.4) 38 (63.3) 3 (9.) 14 (4.) 46 (41.1) 44 (62.0) (4.) 0 (4.9) 19 (.8) 10 (1.4) 69 (3.9) 8 (36.4) 20 (40.0) 8 (9.9) 40 (46.0) 82 (49.) 9 (6.2) 12 (4.) 109 (1.4) (.6) 0.01* J of Evolution of Med and Dent Sci/ eissn , pissn / Vol. 4/ Issue 0/Jan 22, 201 Page 1126

6 Fig. 4 Variables Yes No Total p-value Age 1-20 years 20-2 years 2-30 years >30 years Education Illiterate Primary Secondary Above Secondary Husband Education Illiterate Primary Secondary Above Secondary 41 (36.9) 11 (0.) 3 8 (3.3) 23 (38.3) 20 (32.3) 113 (42.6) 81 (2.3) 2 (38.0) 22 (4.8) 10 (44.9) 83 (6.8) 0 (63.1) 148 (49.) 3 (46.) 3 (61.) 42 (6.) 12 (.4) 31 (2.) 44 (62.0) 26 (4.2) 129 (.1) 63 (43.2) * 0.000** 0.039* J of Evolution of Med and Dent Sci/ eissn , pissn / Vol. 4/ Issue 0/Jan 22, 201 Page 112

7 Area of residence Rural Urban Urban Slum Religion Hindu Muslim Christian Occupation House wife Laborer Service Business 64 (44.1) 109 (1.4) 64 (4.1) 20 (46.8) (3.) 2 (8.1) 226 (4.8) 3 (2.0) (3.8) 1 81 (.9) 103 (48.6) 8 (4.9) 23 (3.2) 9 (64.3) 18 (41.9) 24 (2.2) 9 (.0) 6 (46.2) Table 3: Awareness about over population Method Female sterilisation vasectomy IUD insertions OCP users Condom users Table 4 DISCUSSION: Out of 499 antenatal women, 9.9% are in the age group of 20-2yrs. 42.% are residing in urban areas of Visakhapatnam. 88.6% belonged to the Hindu community. 3.1% these women had secondary education and only 12% are illiterates..% are primi gravidas. Overall awareness of permanent methods of family planning 96.3% and that of temporary methods is only 62.9% (314). 69.9% of women became aware of contraceptive method, by obtaining information from relatives and friends and 23.2% from media (Television). 42.1% are of the opinion that these contraceptive methods are available in the medical shops and only 13% know that they are available in the government hospitals. 99.8% are aware of female sterilization, and 92.8% are aware of J of Evolution of Med and Dent Sci/ eissn , pissn / Vol. 4/ Issue 0/Jan 22, 201 Page 1128

8 vasectomy. But awareness of temporary methods is very poor, only.% are aware of barriers, 2.% IUCD, 20% injectables and 18% OCP and 1% aware of emergency contraception. Knowledge is maximum among women with in the age group of 20-2yr though not statistically significant, awareness increased with increase in the level of education of both women and their partners. Either the area of residence or the religion did not influence the awareness level. Only 46.6% (233 out of 499) practiced some method of FP. 14.2% (1 out of 499) used natural methods, 23.8% used barriers (Condoms), 6.6% used hormonal (OCP/INJECTABLE), and 8.6% used IUCD. Practice of FP method, increased with increasing age of women and their education. Husband s education did not influence the practice level in this study. Other variables did not influence much the level of practice. Accessibility of electronic media to the very interior villages, may be cause that people are kept well informed irrespective of the area of residence. 23.2% (116 out of 499) practiced for 1year. 3.6% (18 out of 499) discontinued as they wanted pregnancy. 21% discontinued with onset side effects. 266 out 499 (3.3%) did not practice any method. 3.1% (18 out of 499) are unaware of any temporary methods, 11.4% ( out of 499) could not practice due the opposition from either husband or in-laws and.4% did not practice due the fear of side effects. Only 289 (8%) has a positive attitude towards FP, 23 (4.%) are aware of the side effects of over population. Fig. Fig. 6 J of Evolution of Med and Dent Sci/ eissn , pissn / Vol. 4/ Issue 0/Jan 22, 201 Page 1129

9 CONCLUSION: Over the 63 years after launching the programme, contraceptive use has been increased. Non-reversible methods (Permanent) have reached the people at the grass-root level. But the temporary methods still remain as figures on paper. In India, gender inequalities favour men. Sexual and reproductive health decisions are usually made by men. (3) 0% of the population are men but, male or couple dependent methods of family planning are limited. Unless men are directly involved, the Family Welfare programme will have limited impact. Direct evidence on the use of male methods is scarce as men have been excluded from most of the national surveys. Studies exposing involvement of men in this programme should come up. (4) Family planning means a well-planned family which includes not only limiting the number of births but also the baby to be born should be welcomed by a well prepared couple. It has been found that most of the women of reproductive age who do not want to have a child soon or ever are not using any contraceptive. Most women prefer to undergo MTP than using any method of family planning. Many Knowledge, attitude and practice surveys revealed that there is no complete correspondence between knowledge and practice (Same is reported in the present study). Low use of temporary methods may be the byproduct of fear of side effects, weak motivation and social and familial disapproval. This could be the reason for the gap between knowledge and practice. Births that women have but do not want constitute a substantial proportion of all births. Moreover, while the total fertility rate has declined to 1.98, the prevalence of unintended pregnancies (Both unwanted & mistimed) has been stagnant.1/4 0f women reported that their pregnancy was unintended (NFHS 111). Unintended pregnancies currently poses one of the greatest challenges associated with women s reproductive health. Unintended pregnancies can have serious health, social and economic consequences for both family and nation. () Negative consequences of unintended pregnancies are risk of low birth weight, prematurity as a result there is an increased risk of infant mortality. At the individual level, preventing unwanted birth enhances wellbeing of women & their children, thus reducing maternal and child mortality (Achieving or reaching Millennium Goal 4&. REFERENCES: 1. Mitali G Patil, Darshan K Mahyavanshi, Girija Kartha et al A Cross sectional study on KAP regarding spacing methods among married women of the reproductive age group in the field practice area of UHTC in Surrendranagar district, Healthline ISSN X, Vol 2, issue 2, July Dec 2011; pg N. K. Saini, M. Singh, D.R. GAUR, R. Kumar, M. Rajput. Awareness and practices regarding spacing methods in urban slums of Rothak. JMC vol. 31, No.2, April-June Aggarwal H, Vaid S, Vaid N. Comparison of the level of awareness of family planning measure in the urban and urban-slum women. Anthropol 200; : Takkar N, Goel P, Saha PK, Dua D. Contraceptive practices and awareness of emergency contraception in educated working women. Indian J Med Sci 200; 9: K. G. Santhya; Changing family planning scenario in India: An overview of recent evidence; South & East Asia Regional working papers 2003, no 1. J of Evolution of Med and Dent Sci/ eissn , pissn / Vol. 4/ Issue 0/Jan 22, 201 Page 1130

10 AUTHORS: 1. Shailaja Pinjala 2. Padmavathi Tatavarthi 3. Syamala G. PARTICULARS OF CONTRIBUTORS: 1. Assistant Professor, Department of Obstetrics and Gynaecology, Andhra Medical College, VSP, A. P. 2. Professor, Department of Obstetrics and Gynaecology, Andhra Medical College, VSP, A. P. 3. Post Graduate, Department of Obstetrics and Gynaecology, Andhra Medical College, VSP, A. P. NAME ADDRESS ID OF THE CORRESPONDING AUTHOR: Shailaja Pinjala, /c, Nandagirinagar, Visakhapatnam Date of Submission: 09/01/201. Date of Peer Review: 10/01/201. Date of Acceptance: 13/01/201. Date of Publishing: 20/01/201. J of Evolution of Med and Dent Sci/ eissn , pissn / Vol. 4/ Issue 0/Jan 22, 201 Page 1131